It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type plasminogen activator receptor (suPAR) levels, and intraoperative sublingual microcirculatory variables in patients undergoing major non-cardiac surgery. Plasma suPAR levels were determined in 100 non-cardiac surgery patients using the suPARnostic^® quick triage lateral flow assay. We assessed sublingual microcirculation before surgical incision and every 30 min during surgery using Sidestream Darkfield (SDF+) imaging and determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Elevated suPAR levels were associated with lower intraoperative De Backer score, Consensus PPV, and Consensus PPV (small). For each ng mL⁻¹ increase in suPAR, De Backer score, Consensus PPV, and Consensus PPV (small) decreased by 0.7 mm⁻¹, 2.5%, and 2.8%, respectively, compared to baseline. In contrast, CRP was not significantly correlated with De Backer score (r = −0.034, p = 0.36), Consensus PPV (r = −0.014, p = 0.72) or Consensus PPV Small (r = −0.037, p = 0.32). Postoperative De Backer score did not change significantly from baseline (5.95 ± 3.21 vs. 5.89 ± 3.36, p = 0.404), while postoperative Consensus PPV (83.49 ± 11.5 vs. 81.15 ± 11.8, p < 0.001) and Consensus PPV (small) (80.87 ± 13.4 vs. 78.72 ± 13, p < 0.001) decreased significantly from baseline. In conclusion, elevated preoperative suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing elective major non-cardiac surgery.

Background/Objectives: Endovascular aneurysm repair (EVAR) of the aorta may trigger an inflammatory response that affects coagulation. In the EVAR of para-renal and thoraco-abdominal aortic aneurysms, the implants are more complex and the duration of surgery is longer. However, the exact pathophysiological mechanisms of coagulation activation are not yet well understood. The primary aim of this study is to investigate the effects of complex EVAR of para-renal and thoraco-abdominal aortic aneurysms on the coagulation status of patients. Methods: This prospective observational study (STROBE), approved and registered by the Ethics Committee of the University Hospital of Larissa (UHL) (NCT06432387), will enroll consecutive patients undergoing elective EVAR of para-renal and thoraco-abdominal aortic aneurysms. Exclusion criteria: Refusal to participate, previous surgery within 3 months, American Society of Anesthesiologists physical status (ASA PS) > 3, known history of thrombophilia or functional platelet dysfunction. Perioperative laboratory tests will be performed according to institutional guidelines. These include a complete blood count, conventional coagulation tests, and kidney and liver function tests. In addition, the following parameters will be determined: von Willebrand factor, factors VIII and XI, D-dimers, fibrinogen, Adamts-13, anti-Xa, platelet activation (multiplate), and high-sensitivity troponin. Blood samples will be taken pre-operatively before induction of anesthesia (01), on postoperative day 1 (02), and on postoperative day 3–4 (03). During hospitalization, myocardial injury after non-cardiac surgery (MINS), major adverse cardiovascular events after non-cardiac surgery (MACE), acute kidney injury (AKI), post-implantation syndrome (PIS), and death from any cause will be recorded. In addition, our patients will be reviewed at 30 days, 3, 6, and 12 months for MACE, implant failure, or death from any cause. All enrolled patients will be treated by the same medical team at UHL according to the indications. According to our power analysis, for a cohort of patients with three consecutive measurements, 58 patients should be included in the study. To compensate for possible dropouts, the sample size was increased to 65 patients. Conclusions: The results of the present study could help physicians to better understand the effects of complex EVAR of para-renal and thoraco-abdominal aortic aneurysms on blood coagulation and platelet activation.

Radical prostatectomy is the standard of care for the treatment of early, clinically localized prostate cancer (PC). In addition to known clinical prognosticators, perioperative conditions and the type of anesthesia may affect clinical outcomes through several mechanisms that favor a tumor-propagating state, including activation of the sympathetic system, increased opioid requirements, and inflammation. In this review, we provide an overview of the impact of the perioperative period on PC prognosis and patient outcomes. A non-systematic literature review was conducted to investigate the possible association between neuraxial anesthesia and outcomes after radical prostatectomy (RP) for prostate cancer. The following keywords were used: “cancer recurrence” OR “cancer prognosis” OR “metastasis” AND “neuraxial anesthesia” AND “prostate cancer”. Eligible studies were summarized in the form of a narrative review. In the era of limited use of ERAS protocols, the implementation of neuraxial anesthesia was found to reduce mortality after RP for primary prostate cancer when compared to general anesthesia. Although there was no significant association between anesthetic technique and radiological or biochemical-free survival, regional anesthesia may have an impact on short-term survival in patients with severe comorbidities, involving pulmonary complications and thrombosis. The effect of anesthetic technique on PC patient outcomes remains elusive, although preliminary retrospective evidence suggests a possible positive effect of neuraxial anesthesia on patient outcomes. As the perioperative period is considered a vulnerable timeframe for these patients, the role of the leadership dyad of surgeon and onco-anesthesiologist is crucial.

Background/Objectives: Chronic persistent postoperative pain after cardiac surgery, first described as Post CABG Pain Syndrome (PCPS), has been a well-recognized problem since 1989. This study investigated the effect of a single preoperatively administrated pregabalin dose on chronic persistent postoperative pain, in terms of pain intensity, rescue analgesia, and sleep disturbances, after elective cardiac surgery. Methods: This is a secondary analysis of a prospective double-blind single center study that took place in a tertiary/referral center (NCT01701921). Consecutive adult patients who underwent elective cardiac surgery with median sternotomy and extracorporeal circulation under general anesthesia were included. Patients were randomly assigned into three groups {placebo (group 1), oral pregabalin 75 mg (group 2), oral pregabalin 150 mg (group 3)}. Placebo or either dose of pregabalin were administered 1 h preoperatively. Postoperatively at 12 and 24 months, the presence of persistent chronic pain (Numeric Rating Scale, NRS), the need of daily intake of analgesics, and any potential sleep disturbances were assessed. Results: In total, 93 out of 108 patients completed this secondary analysis (86,1%). Patients from all three groups reported persistent postoperative pain at 12 and 24 months, respectively. The mean NRS scores at 12 months were 1.71 (0.588) group 1, 1.23 (0.560) group 2, and 1.19 (0.402) group 3. At 24 months, the mean NRS scores were 1.19 (0.543) Group 1, 0.84 (0.454) Group 2, and 0.84 (0.374) Group 3. No statistically important difference was detected between the two different pregabalin groups. Regarding the use of analgesics, Pearson Chi-Square showed p-values p = 0.027 in 12 months and p = 0.01 in 24 months and lower scores were detected in the high pregabalin dose group. As far as the sleep disturbances are concerned, there was no significant difference between groups. The number of patients who reported persistent postoperative pain at 12 and 24 months was significantly lower in the pregabalin groups (75 mg and 150 mg) than in the placebo group. Regarding the NRS score, Kruskal–Wallis showed a value of p = 0.001 and p = 0.005 in 12 and 24 months respectively. Regarding the use of analgesics, Pearson Chi-Square showed p-values p = 0.027 in 12 months and p = 0.01 in 24 months. Referring to sleep disturbances, there was no significant difference between groups. Conclusions: Based on the results of this study, it seems that oral administration of a single preoperative dose of pregabalin may exhibit a significant preventive effect on chronic persistent postoperative pain after elective cardiac surgery.